Ectropion

Question 1

Aetiology

Answer 1

Outward rotation of the eyelid margin - usually lower eyelid, can be unilateral or bilateral. Prevalence increases with age.

Involutional - age-related, most common
- horizontal lid laxity, weakness of pre tarsal part of orbicularis oculi, weakness of medial and lateral canthal tendons, chronic inflammation from bleph/chalazion can make this more likely.

Cicatricial - scarring with or without eyelid skin and tissue contracture. Usually due to trauma, burns, skin tumours, actinic skin changes from sun exposure, chronic blepharitis.

Paralytic - facial nerve palsy

Mechanical - eyelid tumours, lid swelling from infection/allergy

Congenital - rare, usually bilateral, from birth

Question 2

Predisposing factors

Answer 2

Lid laxity with age
Eyelid rubbing
Floppy eyelid syndrome
trauma or prev surgery

Question 3

Symptoms

Answer 3

Sore, red, watery eye
Symptoms depend on severity

Question 4

Signs

Answer 4

Lower lid margin is not in contact with globe - can be punctal, medial, lateral or tarsal (complete), involutional tends to affect medial portion first, then central/lateral later.

Keratinisation of exposed tarsal conjunctiva

Lower punctum not in contact with globe - can see puncture without lid eversion

Conjunctival hyperaemia

Exposure keratopathy

Epiphora

Mucus discharge

Distraction test: to test for medial canthal tendon (MCT) laxity, the lower lid is pulled laterally - if puncture can be pulled to the medial corneal limbus or further, it is said to be lax. To test for lateral canthal tendon laxity, lower lid to be pulled medially.

Snap-back test: lower eyelid is pulled to inferior orbital rim - let go and it should snap back normally. If slow return, eyelid has poor orbicularis tone.

Question 5

Non-pharmacological management

Answer 5

Eyelid taping
CL to protect cornea
Avoid eyelid rubbing

Question 6

Pharmacological

Answer 6

If asymptomatic, none.
If symptomatic, give lubricants and ointments - PF due to long term usage

Question 7

Refer?

Answer 7

Not usually
If requiring surgery or quite severe - refer routinely

Question 8

Management at hospital?

Answer 8

Surgery is indicated for:
ocular surface exposure (increased risk of microbial keratitis)
chronic epiphora or ocular irritation
recurrent bacterial conjunctivitis
poor cosmesis